Distinct patterns of pituitary dysfunction in combination immunotherapy with nivolumab and ipilimumab
Authors' conclusion
Pituitary irAEs are more frequent and develop earlier in patients receiving Nivo/Ipi. CPHD and IAD, induced by this combination immunotherapy, exhibit distinct clinical courses. Recognizing these differences is crucial for the optimal management of pituitary irAEs during combination immunotherapy.
Study context
- Population
- Patients treated with immune checkpoint inhibitors (ICIs) (nivolumab with or without ipilimumab)
- Exposure
- Nivolumab plus ipilimumab vs nivolumab monotherapy
- Outcome
- Clinical features of pituitary irAEs (frequency, onset, symptoms, laboratory findings, pituitary MRI, coexisting irAEs)
Main finding
As reported in the abstract
Pituitary irAEs
Observational data: associations, not effects.
Further findings
Onset of pituitary irAEs
Onset of pituitary immune-related adverse events (irAEs)
- Earlier onset with Nivo/Ipi
Type of pituitary dysfunction
- Nivo: isolated ACTH deficiency (IAD)
- 15
- Nivo/Ipi: IAD
- 8
- Nivo/Ipi: combined pituitary hormone deficiency (CPHD)
- 8
- All Nivo cases were IAD
Onset of CPHD vs IAD within Nivo/Ipi
- Median onset CPHD (days)
- 40
- Median onset IAD (days)
- 84
- CPHD occurred significantly earlier than IAD, with higher incidence of headache and pituitary swelling on MRI
Non-endocrine irAEs in CPHD
- CPHD patients with non-endocrine irAEs
- 75%
Safety
Re-administration of Nivo/Ipi in CPHD
- CPHD patients with worsening symptoms and pituitary dysfunction after re-administration
- 2
Original publication
Distinct patterns of pituitary dysfunction in combination immunotherapy with nivolumab and ipilimumab. Eur J Endocrinol. Published 16 February 2026. doi:10.
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